The measles outbreak in South Carolina shows the chilling effect of vaccine misinformation

The measles outbreak in South Carolina shows the chilling effect of vaccine misinformation

Near the back corner of the local library parking lot, largely out of sight of Main Street, the South Carolina Department of Health opened a pop-up clinic in early November offering free measles vaccinations to adults and children.

Spartanburg County, in Upstate South Carolina, has been battling a measles outbreak since early October, with more than 50 cases identified. Health officials have encouraged people who are not vaccinated to get vaccinated by visiting the mobile vaccination clinic at one of the various stops throughout the county.

But on a Monday afternoon, only one person showed up in Boiling Springs.

"It's progress. This progress is slow," Linda Bell, the state epidemiologist with the Department of Health, said during a recent news conference. “We were hoping to see greater adoption in our mobile health units.”

As South Carolina tries to contain the measles outbreak, health officials across the country fear the highly contagious virus is making a major comeback. The Centers for Disease Control and Prevention has counted more than 1,700 measles cases and 45 outbreaks in 2025. The largest outbreak began in Texas, where hundreds of people were infected and two children died.

For the first time in more than two decades, the United States is on the verge of losing its measles elimination status, a status that indicates outbreaks are rare and quickly contained.

The measles outbreak in South Carolina is not yet as large as in other states such as New Mexico, Arizona and Kansas. But it shows how a confluence of larger national trends — including historically low vaccination rates, pandemic-fueled skepticism, misinformation and “health freedom” ideologies promoted by conservative politicians — has put some communities at risk of a reemergence of a preventable, potentially deadly virus.

“Everyone talks about it being the canary in the coal mine because it is the most contagious infectious disease there is,” said Josh Michaud, deputy director of global and public health policy at KFF, a nonprofit health information organization that includes KFF Health News. “The logic is undeniable that we are likely to see further outbreaks.”

Schools and “small bushfires”

Spartanburg's vaccination rate is among the lowest of South Carolina's 46 counties. And that was true “even before Covid,” said Chris Lombardozzi, senior vice president of Spartanburg Regional Healthcare System.

Nearly 6,000 children in Spartanburg County schools last year — 10% of total enrollment — either received waivers allowing them to forego required vaccinations or did not meet immunization requirements, according to data released by the state.

Lombardozzi said the county's low vaccination rate was due to misinformation not only posted on social media but also spread by "various non-medical leaders over the years."

The pandemic has made everything worse. Michaud said fear and misinformation surrounding Covid vaccines is “pouring gasoline on the fire of people’s vaccine skepticism.” In some cases, that skepticism carried over to childhood vaccinations, which have been less controversial in the past, he said.

That left communities like Spartanburg County with low vaccination rates more vulnerable. “That’s why we see small bushfires all the time during measles outbreaks,” Michaud said.

In Spartanburg, the overall percentage of students with required vaccinations fell from 95.1% to 90% between the 2020-21 and 2024-25 academic years. Public health officials say at least 95% is needed to prevent significant spread of measles.

Children attending public and private schools in South Carolina must prove that they have received some vaccinations, including the measles, mumps and rubella shots, but religious exemptions are relatively easy to obtain. The exemption form must be notarized, but does not require a medical certificate or disclosure of the family's religious beliefs.

The number of South Carolina students granted religious exemptions has increased dramatically over the past decade. That's particularly true in the Upstate region, where religious exemptions have increased sixfold in a decade. During the 2013-14 school year, 2,044 Upstate students were granted religious exemptions from vaccination requirements, according to data published by The Post and Courier. By fall 2024, that number jumped to over 13,000.

Some schools are more at risk than others. The start of the outbreak in South Carolina was largely tied to a public charter school, Global Academy of South Carolina, where only 17% of the 605 students enrolled in the 2024-25 school year provided proof that they had received required vaccinations, according to the state Department of Health.

No one from Global Academy responded to interview requests.

“Health Freedom”

In April, after visiting a Texas family whose daughter had died of measles, Health and Human Services Secretary Robert F. Kennedy Jr. wrote on social media that the "most effective way to prevent the spread of measles is the MMR vaccine." He made a similar statement later that month during an interview on "Dr. Phil."

However, these endorsements contradict other statements made by Kennedy that cast doubt on the safety of vaccines and falsely link vaccines to autism. The CDC, which reports to it, now claims that such connections were “ignored by health authorities.”

“What would I do if I could go back in time and avoid giving my children the vaccines I gave them?” he said in a podcast in 2020. "I would do anything for that. I would pay anything to be able to do that."

He made additional misleading or unsubstantiated statements throughout 2025. During a congressional hearing in September, Kennedy defended his previous claims that he was not an anti-vaxxer, but reiterated his stated position that no vaccines are safe or effective.

Emily Hilliard, a spokeswoman for the Department of Health and Human Services, told KFF Health News that Kennedy is "for safety, transparency and accountability." Hilliard said HHS is working with "state and local partners in South Carolina" and other states to provide support during measles outbreaks.

Meanwhile, Kennedy has frequently championed the idea of ​​health freedom or choice regarding vaccines, a topic of discussion that has gained traction among Republicans.

That has had a "chilling effect on the entire state and local legislature," Michaud said, causing some leaders to be hesitant to talk about the threat posed by the ongoing measles outbreaks or about the effectiveness and safety of the MMR vaccine.

Brandon Charochak, a spokesman for South Carolina Gov. Henry McMaster, said the governor was unavailable for an interview for this article, but referred to McMaster's October comment that measles "is a dangerous disease, but when it comes to disease, we shouldn't panic."

On another occasion this month, the Republican governor said he did not support vaccination mandates. “We’re not going to have mandates,” he said, “and I think we’re responding in the right way.”

Although the South Carolina Department of Health and Human Services has repeatedly promoted measles vaccines, that push has been much quieter than the agency's efforts to distribute Covid vaccines.

In 2021, for example, the agency worked with breweries across the state on a campaign called “Shot and a Chaser,” which rewarded people who received a Covid vaccination with a free beer or soda. In contrast, the pop-up measles vaccination clinic at the Boiling Springs Library had no prominent signage, no freebies, and was not visible from the library's main entrance.

Edward Simmer, interim director of the Department of Health, did not want to speak to KFF Health News about the measles outbreak. At a legislative hearing in April, Republican lawmakers voted against his permanent confirmation because of his past support for Covid vaccines and mask mandates. One lawmaker specifically criticized the agency during that hearing over the shot-and-a-chaser campaign.

Public health officials in other states have also been barred from new roles because of their response to the coronavirus crisis. In Missouri, where MMR vaccination rates among kindergarten students have declined since 2020 and measles cases have been reported this year, Republican lawmakers rejected a public health director in 2022 after anti-vaxxers protested his appointment.

In South Carolina, Simmer is leading the health department in an interim capacity in the absence of legislative approval.

South Carolina Sen. Tom Davis of Beaufort was the only Republican on the Senate Medical Affairs Committee to vote to confirm Simmer in April. He told KFF Health News that his Republican colleagues have asked legitimate questions about Simmer's past support for Covid vaccines.

But, Davis said, it would be "extremely unfortunate and not beneficial from a public health perspective" if the Republican Party took an anti-vaccine stance solely "for political reasons."

The Ministry of Health had administered 44 doses of the MMR vaccine through its mobile health unit from October to mid-November. The last mobile vaccination clinic was scheduled for November 24th. But health officials are encouraged that patients are looking elsewhere for vaccines. The agency's tracking system shows that providers across Spartanburg County administered more than twice as many measles vaccines in October as they did a year ago.

As of mid-November, more than 130 people were still in quarantine, most of them students from local elementary and middle schools. Cases have also been linked to a church and the Greenville-Spartanburg International Airport.

“We remind people that traveling during the upcoming holidays significantly increases the risk of exposure,” said Bell, the state epidemiologist. “Because of this risk, we encourage people to consider vaccination now.”

KFF Health News correspondent Amy Maxmen contributed to this report.

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